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Phase 3b > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Causes of hyponatraemia with >20mmol urinary sodium

A

Addison’s
Diuretics
Renal failure

Euvolaemic - hypothyroidism, SIADH

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2
Q

Prolactinoma treatment

A

Dopamine agonists (cabergoline, bromocriptine)

Trans-sphenoidal surgery

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3
Q

Prolactinoma symptoms?

A

Amenorrhoea, galactorrhoea, impotence, osteoporosis (women), loss of libido

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4
Q

What does a a dexamethasone test entail and what is it used for?

A

Suspected Cushing’s

Low dose 1mg, high dose 8mg

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5
Q

What does a low cortisol following high dose dexamethasone suggest?

A

Cushing’s Disease (i.e. pituitary adenoma)

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6
Q

What does a high/normal cortisol following high dose dexamethasone suggest?

A

High ACTH: ectopic ACTH (small cell lung carcinoma)

Low ACTH: Cushing’s Disease

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7
Q

What are the ACTH dependent and ACTH independent causes of Cushing’s?

A

Dependent: Pituitary adenoma (Cushing’s disease), ectopic ACTH (small cell carcinoma)

Independent: iatrogenic steroids, adrenal adenoma

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8
Q

What are two syndromes associated with hypothyroidism?

A

Down’s

Turner’s

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9
Q

Causes of primary hypothyroidism

A 
Hashimoto's hypothyroidism 
Subacute thyroiditis (De Quervain's)
Riedel thyroiditis 
Post-thyroidectomy or radioiodine treatment 
Drug therapy e.g. lithium, carbimazole)
Dietary iodine deficiency
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10
Q

What are Sertoli cells stimulated by and what do they produce?

A

Stimulated by FSH

Produce sperm and jnhibins A and B

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11
Q

What are Leydig cells stimulated by and what do they produce?

A

Stimulated by LH

Produce testosterone

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12
Q

What is the role of Inhibin

A

Negative feedback on pituitary to decrease FSH

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13
Q

What is the role of FSH and LH in the female?

A

LH stimulates theca cells to produce androgens

FSH stimulates follicular development and oestrogen production (from androgens) in granulosa cells

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14
Q

When does puberty in boys start and finish?

A

10-14

15-17

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15
Q

What antibodies are seen in Hashimoto’s?

A

Anti-TPO

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16
Q

35-year-old woman is found to have a blood pressure of 180/110 mmHg. She complains of feeling tired and weak. Routine bloods show hypokalaemia

A

Primary hyperaldosteronism

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17
Q

40-year-old woman presents with lethargy, weakness and weight loss. On examination her blood pressure is 80/50 mmHg and there is hyperpigmentation of the skin

A

Addison’s

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18
Q

Features of primary hyperaldosteronism

A

Tiredness
Hypertension (due to resorption of sodium)
Hypokalaemia - muscle weakness
Alkalosis

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19
Q

Primary hyperaldosteronism investigations and management

A

Aldosterone/renin ratio - raised aldosterone, low renin (negative feedback from retained sodium)

CT scan and Adrenal Venous Sampling (AVS) - uni or bilateral

Adrenal adenoma - surgery

Bilateral adrenocortical hyperplasia - aldosterone antagonist (spironolactone)

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20
Q

A 60-year-old woman is investigated for heat intolerance and weight loss. The free T4 level is elevated and the TSH is suppressed. Nuclear scintigraphy reveals an enlarged thyroid gland with patchy uptake. Diagnosis?

A

Toxic multinodular goitre

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21
Q

What antibodies are present in Grave’s disease?

A

TSH receptor antibodies

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22
Q

What electrolyte imbalance can sarcoidosis cause?

A

Hypercalcaemia

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23
Q

What is the action of SGLT-2 inhibitors?

A

Inhibits reabsorption of glucose in the kidney
Risk of weight loss, genital infections and DKA (increases glucose secretion by kidneys)
Don’t give in thrush patients!

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24
Q

Action of metformin?

A

Increases insulin sensitivity

Decreases hepatic gluconeogenesis

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25
Q

Characteristics of sick euthyroid syndrome?

A

Systemic illness
Inappropriately normal TSH with low T3
Returns to normal when recovers from underlying illness

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26
Q

What are the endocrine side effects of corticosteroids?

A 
Impaired glucose control (anti-insulin effect)
Weight gain and appetite 
Hirsutism 
Hyperlipidaemia 
Cushing's syndrome
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27
Q

What are the non-endocrine side effects of corticosteroids?

A 
Glucocorticoids 
Avascular necrosis of the femoral head 
Psych: depression, mania, insomnia, psychosis
Immunosuppression 
GI: peptic ulceration, acute pancreatitis 
Eyes: glaucoma, cataracts
Intracranial hypertension 
Neutrophilia
Osteoporosis 
Growth suppression in children

Mineralcorticoids
Hypertension
Fluid retention

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28
Q

What is the action of sulfonylureas and who should they be avoided in?

A

Increases insulin secretion by beta cells

Avoid if pregnant or breastfeeding or at risk of hypoglycaemia

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29
Q

What condition is associated with initial few weeks painful goitre, ESR and hyperthyroidism followed by hypothyroidism and raised ESR? And what is management?

A

Subacute thyroiditis (de Quervain’s)

Self-limiting (steroids if severe)

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30
Q

Side effects of metformin (biguanides)?

A

GI upset, lactic acidosis in those with renal failure

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31
Q

Primary hyperparathyroidism characteristics

A 
Elderly lady with: 
Renal stones
Bone pain
Peptic ulceration/constipation 
Renal stones
Depression  
Polydipsia, polyuria

Associated with:
HTN
MEN I and II

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32
Q

Addison’s characteristics

A

Lethargy, weakness, anorexia, nausea, vomiting, abdominal pain, salt craving, muscle wasting

Hyperpigmentation of palmar creases and mucous membranes, vitiligo, loss of pubic hair

Hyperkalaemia, hyponatraemia, hypoglycaemia, hypotension

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33
Q

Toxic multinodular goitre characteristics and management

A

Autonomously functioning nodules in thyroid resulting in hyperthyroidism

Patchy uptake with nuclear scintigraphy

Radioiodine therapy

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34
Q

Thyrotoxicosis treatment

A

Propanalol for symptom management

Carbimazole (reduces thyroid hormone production) - agranulocytosis risk

Radioiodine treatment

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35
Q

What drug can cause thyrotoxicosis?

A

Amiodarone

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36
Q

40-year-old patient with a history of hypertension presents with episodic palpitations, excessive sweating, headaches and tremor

A

Pheochromocytoma

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37
Q

What is pheochromocytoma?

A

Catecholamine secreting tumour associated with MEN II and neurofibromatosis

Hypertension, palpitations, sweating, headaches, anxiety

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38
Q

Investigation and management of pheochromocytoma

A

24 hr urinary collection of metanephrines

Alpha blocker (phenoxybenzamine) 
Beta blocker (propanalol)
Surgery 10 days later to remove tumour
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39
Q

Pioglitazone side effects

A 
Weight gain 
Fluid retention (DONT GIVE IN HEART FAILURE)
Liver impairment (monitor LFTs)
Risk of bladder cancer 
Risk of fractures
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40
Q

Action and side effects of GLP-1 agonists (-tides)

A

Incretin mimetic which inhibits glucagon secretion and enhance glucose-dependent insulin secretion

SEs: Nausea, vomiting, weight loss and pancreatitis

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41
Q

A patient presents with muscle cramping and perioral paraesthesia two months after having thyroid surgery - primary hypoparathyroidism

A

Primary hypoparathyroidism

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42
Q

Treatment of hypoparathyroidism

A

Alfacalidol

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43
Q

MEN I features

A

Peptic ulceration, hypercalcaemia, galactorrhoea

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44
Q

MEN I endocrine organs?

A

3 Ps
Pituitary
Pancreas (Zollinger Ellison - ulcers/gastric acid; insulinoma)
Parathyroid

(also adrenal and thyroid)

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45
Q

2-month-old baby is noted to have hypotonia, macroglossia and a puffy face. They were treated at birth for neonatal jaundice

A

Congenital hypothyroidism

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46
Q

newborn baby is noted to have ambiguous genitalia. At 2 weeks they develop severe vomiting, dehydration and weight loss

A

Congenital adrenal hyperplasia

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47
Q

Klinefelter’s syndrome characteristics

A 
Small, firm testes 
Raised gonadotrophin levels, but low testosterone 
Above average height
Ambiguous secondary characteristics 
Infertile 
Gynaecomastia

Dx by karyotype testing (karyotype 47 XXY)

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48
Q

hypokalaemia, hypertension, alkalosis, no similar family history, raised aldosterone

A

Conn’s Syndrome

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49
Q

a baby is born with ambiguous genitalia, exhibiting labioscrotal folds with clitoromegaly. At 13 years of age the child undergoes virilization with facial hair and deepening of the voice

A

5-alpha reductase deficiency

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50
Q

tall, slim 18-year-old man presents with hypogonadism. He also complains of anosmia. Gonadotrophin levels are reduced

A

Kallman’s Syndrome

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51
Q

Features of congenital hypothyroidism

A 
Prolonged neonatal jaundice
Delayed mental and physical milestones
Puffy face 
Macroglossia 
Hypotonia 
Short stature
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52
Q

hypokalaemia, hypertension, alkalosis, family history of similar problems, low aldosterone

A

Liddle’s syndrome

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53
Q

Conn’s syndrome features

A 
No family hx 
Hypokalaemia 
Hypertension 
Alkalosis 
Raised aldosterone
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54
Q

De Quervain’s/subacute thyroiditis phases

A

Phase 1 (3-6 weeks): thyrotoxicosis, raised ESR, painful goitre (viral illness)

Phase 2 (weeks): euthyroid

Phase 3 (months): hypothyroidism

Phase 4: back to normal

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55
Q

What effect does cortisol have on kidneys and electrolytes?

A

Increases water and sodium retention
Increases potassium excretion
Hypokalaemic metabolic alkalosis

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56
Q

Myxoedema coma features

A 
Confusion and fatigue
Hypothermia 
Ankle swelling 
Reduced respiratory rate and HR
Initial diastolic HTN followed by hypotension 
Hair thinning 
Cool dry skin
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57
Q

Myxoedema coma precipitating factors and treatment

A

Viral illness
Amiodarone
Beta blockers
Surgery, stroke, trauma

Tx: IV thyroid replacement, steroids, fluid
Correct electrolyte imbalances

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58
Q

Thyroid cancer with worst prognosis

A

Anaplastic (elderly patients)

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59
Q

Most common thyroid cancer and characteristics

A

Papillary
Young females, cervical lymph node mets
Thyroglobulin used as tumour marker
Characteristic Orphan Annie eyes on light microscopy

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60
Q

Follicular thyroid cancer characteristics

A

> 50 females
Lung and bone mets
Thyroglobulin used as tumour marker
Usually solitary nodule

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61
Q

Addison’s treatment

A

Hydrocortisone (glucocorticoid): 15-30mg in divided doses (should follow work pattern for shift workers)
Fludrocortisone (mineralocorticoid): 50-300mcg (adjusted to exercise levels and metabolism)

MedicAlert bracelet and steroid card
Double hydrocortisone during illnesses

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62
Q

T1 diabetic blood glucose targets

A

4-7mmol/L before meals

5-7mmol/L on waking

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63
Q

Addisonian crisis causes, features and treatment

A

Sepsis or surgery; infection in Addison patient; adrenal haemorrhage; abrupt withdrawal of steroids (most common)

Confusion with - hyponatraemia, hypotension, hypoglycaemia, hyperkalaemia, dehydration

100mg IV hydrocortisone and 1L saline (with dextrose if hypoglycaemic).

Continue hydrocortisone 6 hourly until stable. Oral replacement after 24 hours.

Monitor electrolytes

Fludrocortisone added for long–term management

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64
Q

Causes of Addison’s

A

Autoimmune adrenalitis (developed countries)
TB (worldwide)
Metastises
Amyloidosis

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65
Q

Causes and features of DKA

A

Causes: missed insulin, infection, MI

Features: vomiting, abdominal pain, polyuria, polydipsia, dehydration, Kussmaul breathing, acetone breath smell

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66
Q

Diagnostic criteria for DKA

A

Blood glucose >11mmol/L or known DM
pH <7.3
Bicarbonate <15mmol/L
Ketones >3mmol/L or ++ on urine

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67
Q

Initial DKA management

A

1L normal saline over an hour (add potassium for following hours)

Insulin: O.1ml/kg/hour - when BM <15mmol/L then start 5% dextrose

Long-acting insulin continued

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68
Q

What are young DKA patients at risk of with treatment, what are the features and how should you adapt?

A

Risk of cerebral oedema - headache, irritability, visual disturbance, focal neuropathy

Give slower infusion

CT scan if suspected

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69
Q

When should you replace potassium in DKA?

A

<5.5mmol/L

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70
Q

Complications of DKA and its treatment

A

Gastric stasis
AKI
Arrhythmias secondary to hyperkalaemia/hypokalaemia
Incorrect fluid management leading to hypokalaemia, hypoglycaemia or cerebral oedema
ARDS

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71
Q

What characteristics would you see in someone with congenital adrenal hyperplasia?

A

Early menarche, hirsutism, large stature (virilization - in response to low cortisol pituitary produces raised levels ACTH, leading to increased adrenal androgen production)

Low cortisol, low sodium, raised potassium

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72
Q

What is the commonest cause of congenital adrenal hyperplasia?

A

Deficiency of 21-hydroxylase enzyme (responsible for aldosterone and cortisol synthesis)

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73
Q

How often should HbA1C be monitored in T1 diabetics and what should the target be?

A

Every 3-6 months

Below 48mmol/mol

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74
Q

How often should a T1 diabetic with well-controlled BM be monitoring blood glucose?

A

4 times a day including before each meal and before bed

Increase during illness, if hypoglycaemic episodes increase, when planning pregnancy, during pregnancy and breastfeeding

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75
Q

Diagnosis of T2 diabetes?

A

Random glucose >11.1mmol/mol
Fasting glucose >7mmol/mol
HbA1C >48mmol/L (if symptomatic)

If asymptomatic need 2 readings

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76
Q

Indications for prescribing growth hormone therapy?

A

Prader-Willi syndrome
Turner Syndrome
Chronic renal insufficiency before puberty
Proven growth hormone deficiency

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77
Q

Adverse effects of growth hormone therapy

A

Headaches
Benign intracranial hypertension
Fluid retention

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78
Q

Turner syndrome signs and symptoms

A 
PRIMARY AMENORRHOEA (fibrosed ovaries)
HYPOTHYROIDISM (and other AI conditions)
Bicuspid aortic valve or coarctation of the aorta  
Webbed neck 
Lymphoedema in neonates
Low set ears 
Wide spaced nipples 
Horseshoe kidney
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79
Q

Test to differentiate between T1 and T2 diabetes

A

C-peptide (low in T1 as pancreas not making enough insulin precursor which breaks down into C-peptide and insulin; normal/high in T2)

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80
Q

Advice for T1 diabetics during illness?

A

Monitor blood glucose more frequently
Continue same insulin doses
Monitor urinary ketones every 4 hours

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81
Q

What type of drug is sitagliptin and when would you add it to a regimen?

A

DDP-4 inhibitor (doesn’t cause weight gain)

If a thiazolidinedione is contraindicated due to weight or poor response

82
Q

What is GLP-1?

A

Glucagon-like peptide 1, produced by the small intestine in response to raised glucose levels

GLP-1 is an analogue
DDP-4 inhibits its breakdown

83
Q

Give an example of a GLP-1 and its adverse effects

A

Exenatide
Nausea and vomiting
Causes weight loss

84
Q

Hyperosmolar Hyperglycaemic State characteristics

A

T2 diabetic
General: lethargy, vomiting, recurrent infections

Neurological: headaches, papilloedema, reduced consciousness, weakness

CV: dehydration, hypotension, tachycardia

85
Q

HHS diagnosis

A 
Raised blood glucose >30mmol/mol
Mild ketonaemia (<3mmol/mol)
Hypovolaemia 
Raised serum osmolarity
pH >7.3 (less acidotic than DKA)
86
Q

HHS management

A

0.9% saline to reduce osmolality and replace fluids (use 0.45% if osmolarity not restoring)

Monitor osmolarity, sodium and glucose on a graph

Target glucose: 10-15mmol/mol

87
Q

When should you give insulin to HHS patient?

A

ONLY if significant ketonaemia

88
Q

What is the inheritance pattern of maturity onset diabetes of the young?

A

Autosomal dominant

89
Q

Characteristics of MODY

A

<25
Family history
Ketosis rare
Sensitivity to sulfonylureas (insulin rarely needed)

90
Q

What condition would give a lower than expected HbA1C?

A

Sickle Cell Anaemia due to reduced RBC lifespan

91
Q

What conditions would give a higher than expected HbA1C? (due to increased RBC lifespan)

A

Vitamin B12/folic acid deficiency
Splenectomy
Iron-deficiency anaemia
Alcoholism

92
Q

Main carbimazole side effect

A

Agranulocytosis

93
Q

Management of Graves’

A

Anti-thyroid (carbimazole) followed by thyroxine when euthyroid

Radioiodine treatment

Propanalol to block adrenergic effects

94
Q

Radioiodine treatment contraindications and side effects

A

Pregnancy (don’t get pregnant at least 4-6 months after treatment)

Thyroid eye disease (precipitates)

Side effects: thyroid eye disease, hypothyroidism

95
Q

Common non-diabetic causes of hypoglycaemia

A 
EXogenous drugs (alcohol, quinine, ACE-i)
Pituitary insufficiency 
Liver failure
Addison's disease
Islet cell tumours (insulinoma)
Non-pancreatic neoplasms
96
Q

Management of subclinical hypothyroidism

A

> 65 - watchful waiting
<65 and symptomatic - start trial of levothyroxine
If >10mU/L of TSH and asymptomatic - start levothyroxine (unless elderly)
Asymptomatic - repeat TFTs in 6 months

97
Q

Definition of subclinical hypothyroidism

A

raised TSH, normal T3 and T4

Asymptomatic

98
Q

What are the main effects of a pituitary adenoma?

A

Excess of hormones (e.g. Cushing’s disease, acromegaly or excess prolactin)

Depletion of hormones due to compression of pituitary

Stretching of dura (headaches)

Compression of optic chiasm (bitemporal hemianopia)

99
Q

Investigations for pituitary adenomas

A

Pituitary blood profiles: GH, ACTH, prolactin, FSH, LH, TFTs

Formal visual fields

MRI brain

100
Q

What is CA 19-9 a marker for?

A

Pancreatic cancer

101
Q

What hormone do medullary cancers usually produce?

A

Calcitonin

102
Q

What is gliclazide and what side effects are there?

A

Sulfonylurea

Weight gain and hypoglycaemia

103
Q

Management of thyroid patient with visual changes?

A

Urgent specialist review (especially loss of colour vision)

104
Q

Type 1 diabetic with bloating, vomiting, and impaired glucose control - diagnosis and management

A

Gastroparesis (neuropathy of vagus nerve)

Mx: Metoclopramide or erythromycin

105
Q

What is Whipple’s triad and what does it diagnose?

A

Symptoms and signs of hypoglycaemia
Hypoglycaemia (<2.5mmol/L)
Reversibility of symptoms on administration of glucose

INSULINOMA
C-peptide levels do not fall on insulin administration (endogenous levels are not reduced)

106
Q

Effect of insulin

A

Causes liver, skeletal muscle and fat cells to absorb glucose
Liver and skeletal muscle: glycogen
Fat cells: triglycerides

107
Q

Causes of raised prolactin

A 
Pregnancy 
Prolactinoma
Physiological 
PSCOS
Primary hypothyroidism
Phenothiazines, metocloPramide, domPeridone
108
Q

High calcium, high or inappropriately normal PTH

A

Primary hyperparathyroidism

109
Q

Cause of secondary hyperparathyroidism

A

Chronic hypocalcaemia e.g. CKD

Low or normal calcium and high PTH

110
Q

Cause of tertiary hyperparathyroidism

A

Secondary hyperparathyroidism resulting in autonomous PTH secretion (end-stage renal disease patients)
high PTH
Mildly raised calcium

111
Q

What should T2 diabetics be given when started on insulin

A

Glucagon kit for hypos

Also should have sweets or juices ready

112
Q

Most common presentation of MEN I

A

Hypercalcaemia

113
Q

MEN IIa and b associations

A

Medullary thyroid cancer, phaeochromocytoma and RET oncogene

IIa: hyperparathyroid
IIb: marfanoid body habitus, neuromas

114
Q

T2 diabetic on lifestyle changes target glucose

A

48

115
Q

T2 diabetic with lifestyle and metformin target

A

48

116
Q

T2 diabetic on one drug but HbA1C increased to >58 - whats the target?

A

53

117
Q

What is the gene in MEN I

A

MEN gene

118
Q

How can you distinguish between an insulinoma and someone injecting insulin?

A

Insulinoma: high c-peptide

Exogenous insulin: low/normal c-peptide

119
Q

What are the DVLA restrictions for a diabetic on insulin who wants an HGV license?

A

No severe hypoglycaemic episodes in past 12 months

Full hypoglycaemic awareness

Good glucose control, with twice daily monitoring and at times relevant to driving

No other debarring complications

120
Q

Klinefelter’s syndrome blood results

A

High gonadotrophins (FSH/LH)
Low testosterone
PRIMARY HYPOGONADISM

121
Q

What is the CT head finding on the skull with hyperparathyroidism?

A

Pepper pot skull

122
Q

What is the purpose of Kussmaul breathing

A

Deep and laboured to expel excess CO2 with metabolic acidosis

123
Q

DKA blood results

A

Hyponatraemia
Low bicarbonate
Normal-high potassium (although insulin therapy can cause hypokalaemia and arrhythmias)

124
Q

What is Zollinger-Ellison Syndrome and when might you see it?

A

Gastrin-secreting tumour in the islet cells of the pancreas or duodenal wall leading increased HCl production gastric antrum. This results in duodenal ulcers.

Seen in MENI

125
Q

Insulin side effects

A

Weight gain, lipodystrophy, hypoglycaemia

126
Q

Name an aldosterone antagonist given to someone with bilateral adrenal hyperplasia

A

Spironolactone

127
Q

What is the primary action of orlistat?

A

Pancreatic lipase inhibitor (decreases breakdown and absorption of lipids)

128
Q

Side effects of thyroxine treatment

A

Hyperthyroidism
Reduced bone mineral density
Exacerbation of angina
AF

129
Q

T2 BP targets (end organ and no end organ damage)

A

No end organ damage: <140/80

End organ damage: <130/80

130
Q

What is Trosseau’s sign?

A

Hypocalcaemic patient

On inflation of BP cuff past systolic, wrist flexes and fingers adduct

131
Q

OGTT at 2 hours for impaired glucose tolerance?

A

7.8-11.1 mmol/mol

132
Q

How do thyroid problems affect periods?

A

Hyperthyroidism: amenorrhoea or oligomenorrhoea

Hypo: menorrhagia

133
Q

Most common cause of primary hyperparathyroidism?

A

Solitary parathyroid adenoma

134
Q

What can ACTH be cleaved into, and what does that then effect?

A

melanocyte stimulating hormone resulting in hyperpigmentation (especially of oral mucosa and palmar creases)

135
Q

Highest and lowest points of cortisol levels?

A

Highest: 8am
Lowest: midnight/1am

136
Q

What causes an increase in renin levels?

A

Renal artery hypotension
Sympathetic nervous stimulation
Reduce sodium levels in distal tubule

137
Q

What is renin’s action?

A

Cleaves angiotensinogen into angiotensin I

138
Q

Role of ACE and where is it found?

A

Converts angiotensin I into angiontensin II

Found in vascular epithelium of the lung

139
Q

Angiotensin II function?

A

Stimulates ADH release
Sodium reabsorption
Aldosterone (mineralcorticoid) release
Vasoconstriction

140
Q

What is aldosterone released in response to, and what are its effects?

A

Release due to: angiotensin II, ACTH, potassium levels

Effects: increases number of epithelial sodium channels in distal tubule - sodium and water reabsorption, potassium excretion

141
Q

Causes of adrenal insufficiency?

A

Worldwide: TB

Developed: autoimmune (destruction of 21-hydroxylase)

Rarer: metastases, HIV, meningococcal sepsis (causing haemorrhage), amyloid deposits, bilateral adrenalectomy

142
Q

Investigations for Addison’s

A

8am cortisol level:
< 100 nmol/L: admit to hospital

100–500 nmol/L: refer for synacthen test, consider admission if symptoms are severe

> 500 nmol/L: Addison’s is unlikely

143
Q

What is the synacthen test?

A 
250mcg tetracosactide (synacthen)
Cortisol measured at 0, 30 and 60 mins

Should be >430 nmol/L

144
Q

Different adrenal cortex layers and what they produce

A

Zona glomerulosa - mineralcorticoids
Zona fasciculata - glucocorticoids
Zona reticularis - androgens

145
Q

What is the adrenal medulla responsible for producing?

A

Catecholamines (derived from tyrosine)

  • dopamine
  • adrenaline
  • noradrenaline
146
Q

Cushing’s syndrome signs and symptoms

A

Head: buffalo hump, facial flush, moon face
Body: hypertension, oedema, muscle wasting, acne, thin skin, striae,

Symptoms: lethargy, weight gain, depression, easy bruising, amenorrhoea, reduced libido

147
Q

Cushing’s treatment

A

Medical: metyrapone (11beta-hydroxylase inhibitor - reduces cortisol)

Surgical: transphenoidal pituitary resection, adrenalectomy, ectopic tumour excision

148
Q

Cushing diagnosis - primary investigations

A

24 hour urinary cortisol
Midnight cortisol
Low dose dexamethasone

149
Q

How does cortisol lead to osteopenia?

A

Inhibits osteoblast activity

Inhibits vitamin D so reduces calcium reabsorption in intestines

150
Q

Gigantism definition

A

Excessive GH secretion in childhood before epiphyseal fusion: height >2sd for patient’s age and sex

151
Q

Where is IGF-1 released from and what effect does it have on GH?

A

Released from liver
Negative feedback on GH
Stimulates somatostatin (which also is a negative regulator of GH)

152
Q

Signs and symptoms of acromegaly

A

Mass effect: visual changes and headaches

Face: enlarged lips and nose, wide spaced teeth, deep skin creases

Body: large hands and feet, hyperpigmentation, aganthosis nigricans

Carpal tunnel syndrome
Increased risk of arrhythmias, hypertension, cardiomyopathy

153
Q

What cancer are you more at risk of in acromegaly?

A

Colorectal

154
Q

Gigantism features?

A

Mass effect: visual changes and headaches

Face: frontal bossing, coarse facial features

Obesity, tall stature, large hands and feet

155
Q

Acromegaly investigations

A

Serum IGF-1

Oral glucose tolerance test: 100g oral glucose, measure GH before and after (should be suppressed below <0.6mcg/L if normal)

MRI pituitary

156
Q

Acromegaly management

A
  1. Surgical (microadenomas more successful, recurrence of all adenomas is 10%)
  2. Radiotherapy (usually combined with medical therapy, risk of hypopituitarism - avoid if reproductive age)
  3. Medical therapy:
    somatostatin receptor agonists (octreotide) bridge to surgery

dopamine agonist (bromocriptine) shrink tumours

GH antagonists

157
Q

Effects of growth hormone

A

Increased lipolysis, protein synthesis and gluconeogenesis
Increased bone mineralisation
IGF-1 release

158
Q

Causes of carpal tunnel syndrome

A 
Pregnancy
Rheumatoid arthritis
Acromegaly
Glucose
Mechanical (e.g. fractures)
Amyloid deposits
Thyroid underactive
Infection
Crystals (gout)
159
Q

T2 diabetic with hypoglycaemia and low GCS - management?

A

100ml of 20% Glucose IV

Buccal glucose if normal GCS

160
Q

Features seen in Graves but not other hyperthyroidism causes

A

Eye disease (exophthalmos, ophthalmoplegia, glaucoma, proptosis)

Thyroid acropachy (soft tissue swelling of hands and feet, clubbing, periostitis)

Pretibial myxoedema (mucopolysacharide deposition)

161
Q

Initial management of hypercalcaemia

A

3-4L IV saline

Bisphosphonates

162
Q

Complications of thyroidectomy

A

Laryngeal nerve palsy (hoarse voice)

Hypoparathyroidism –> hypocalcaemia (tingling peripheries)

163
Q

Effects of thyroxine on the body

A

BMR: increases Basal Metabolic Rate

Heart: increases heart rate and contractility (increases sensitivity to catecholamines)

Growth: increases release and effect of GH and IGF-1

Metabolism: anabolic at low levels, catabolic at high levels

164
Q

Hyperthyroid causes of thyrotoxicosis

A

Grave’s
Toxic multinodular goitre
Solitary toxic adenoma
Amiodarone-induced thyrotoxicosis type 1 (increased iodine uptake)
Pituitary adenoma
Beta-HCG (mimics TSH) - pregnancy, hydatidiform mole

165
Q

Causes of thyrotoxicosis without hyperthyroidism

A

De Quervain’s (inflammation of thyroid)

Amiodarone-induced thyrotoxicosis type 2 (destructive thyroiditis)

Levothyroxine

Follicular thyroid cancer

166
Q

Grave’s symptoms

A

Goitre
Proptosis, lid lag, ophthalmoplegia, dry eyes
Visual loss
Fine tremor
Sweating
Palpitations, tachycardia, arrhythmia, high output cardiac failure
Hyperreflexia
Hyperdefacation, weight loss, increased appetite
Pretibial myxoedema
Oligomenorrhoea, menorrhagia

167
Q

Grave’s ophthalmopathy classification

A 
No signs or symptoms
Only signs
Soft tissue involvement 
Proptosis 
Extra ocular involvement 
Corneal involvement 
Sight loss

SPECS- refer, steroids, irradiation, surgical decompression

168
Q

Subclinical hyperthyroidism

A

Low TSH

Normal T4

169
Q

Radiodine treatment risks

A

Increased risk of Graves’ eye disease

CI in pregnancy or breastfeeding

170
Q

Thyrotoxic crisis presentation

A

Hyperthermia, nausea, vomiting, hypertension, tachycardia, arrhythmias, seizures, cognitive decline

171
Q

Thyrotoxic crisis management

A

Beta blockers

Thionamides (propylthiouracil) - antithyroid and blocks T4 conversion to T3

Corticosteroids - blocks T4 to T3 conversion

Dialysis or plasma exchange may be required

172
Q

What is your treatment of choice for a woman in 1st trimester of pregnancy with thyrotoxicosis

A

Propylthiouracil (change to carbimazole in 2nd trimester as prop assoc with liver injury)

Dose titration (NOT block and replace)

173
Q

What are beta blockers in pregnancy associated with?

A

IUGR
Fetal bradycardia
Neonatal hypoglycaemia

174
Q

Who can’t you give pioglitazone (thiazolidinediones)?

A

Someone with heart failure

175
Q

Which steroid has least mineralocorticoid (fluid-retention) activity and when would you use it?

A

Dexamethasone (anti-inflammatory)

Raised ICP secondary to brain tumour

176
Q

First line treatment for diabetic neuropathy?

A

Amitriptyline. pregabalin, gabapentin, duloxetine

Tramadol as rescue therapy for exacerbations

Capsaicin for localised neuropathic pain

177
Q

After metformin, what drug would you generally give to a non-obese patient and why? Who would you avoid it in?

A

Sulfonylurea (gliclazide) as most effective at reducing blood glucose

Avoid if patient need to avoid hypoglycaemia (e.g. professional drivers) as risk of hypoglycaemia

178
Q

HbA1c target if patient on a drug with hypoglycaemic risk?

A

53

179
Q

Which hormones are reduced in the stress response?

A

Insulin
Oestrogen
Testosterone

180
Q

Which blood pressure medication is given to patients diagnosed with phaeochromocytoma and why?

A

Labetalol

Has both beta and alpha blocker mechanism (reduces cardiac output and peripheral vascular resistance)

181
Q

Why might a patient with long-standing T1 diabetes have reduced hypoglycaemic awareness?

A

Neuropathy of the autonomic nervous system

182
Q

Potassium management in patient with DKA

A

> 5.5: none
3.5-5.5: 40
<3.5: specialist review

Start giving potassium along with IV fluids after first hour

183
Q

When should you add dextrose to DKA management?

A

Blood glucose <15mmol/L

184
Q

When should you add metformin to a T1 diabetic’s management?

A

BMI >25

185
Q

Initial management of T1 diabetic

A

Basal-bolus insulin regimen with twice-daily insulin detemir

186
Q

Treatment of choice for maturity onset diabetes in the young (with HNF-1 alpha)?

A

Sulfonylurea (gliclazide)

187
Q

Causes of gynaecomastia

A

Testicular failure or cancer (e.g. mumps)
Ectopic tumour secretion
Physiological with puberty
Drugs (spironolactone, digoxin)
Liver disease
Hyperthyroidism
Syndromes with androgen deficiency (Klinefelters, Kallmans)

188
Q

Management of pituitary incidentaloma?

A

Lab screening for hormone secretions - is it functional or non-functional??

189
Q

Indications for surgical removal of pituitary tumour?

A

Hypersecreting tumour (other than prolactinoma)
Visual disturbance
Pressure on optic nerves or chiasm
Pituitary apoplexy

190
Q

How many units of insulin in 1ml?

A

1000

191
Q

Causes of pseudo Cushings

A

Alcohol abuse

Depression

192
Q

What electrolyte is necessary for PTH secretion, and thus what effect will a deficiency of it have on calcium levels?

A

Magnesium

Low magnesium results in low calcium

193
Q

Characteristics of benign adenomas?

A

Lipid-rich core

Well-circumscribed

194
Q

Diabetes inspidus treatment

A

Desmopressin

195
Q

Pituitary apoplexy

A

Headache and visual field loss

Investigations: bloods, visual fields, MRI and CT

Treatment: hydrocortisone 100mg bolus (followed by 50-100 doses)

196
Q

Complication of transsphenoidal surgery?

A

Postoperative diabetes insipidus

197
Q

Drug causes of hyponatraemia

A 
Omeprazole 
Sodium valproate, carbamazepine
Diuretics/ace-i
Desmopressin 
Sertraline 
Ecstasy
198
Q

Medical causes of hyponatraemia?

A

All organ failures (liver, cardiac, kidney, thyroid, adrenal)

199
Q

A 19-year-old lady is admitted to ITU with severe meningococcal sepsis. She is on maximal inotropic support and a CT scan of her chest and abdomen is performed. The adrenal glands show evidence of diffuse haemorrhage.

A

Waterhouse-Friderichsen Syndrome

200
Q

Which steroid has the most glucocorticoid (anti-inflammatory) activity and least mineralocorticoid (fluid retention)

A

Dexamethasone

Phase 3b (18 decks)

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